Responsiveness of Noninvasive Continuous Cardiac Output Monitoring During the Valsalva Maneuver

2018 ◽  
Vol 29 (2) ◽  
pp. 127-132
Author(s):  
L. J. Delaney ◽  
R. Bellomo ◽  
F. van Haren
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Cardiac Index ◽  
Stroke Volume ◽  
Hemodynamic Monitoring ◽  
Valsalva Maneuver ◽  
Cardiac Output Monitoring ◽  
Hemodynamic Changes ◽  
Dynamic Changes ◽  
Output Monitoring

To describe the baseline hemodynamic variables and response time of hemodynamic changes associated with the Valsalva maneuver using noninvasive continuous cardiac output monitoring (Nexfin). Hemodynamic monitoring provides an integral component of advanced clinical care and the ability to monitor response to treatment interventions. The emergence of noninvasive hemodynamic monitoring provides clinicians with an opportunity to monitor and assess patients rapidly with ease of implementation. However, the responsiveness of this method in tracking dynamic changes that occur has not been fully elucidated. A prospective observational study was conducted involving 44 healthy volunteers (age = 38 ±12 years). Participants performed a Valsalva maneuvers to illicit dynamic changes in blood pressure, cardiac output, cardiac index, systemic vascular resistance index (SVRI), and stroke volume. Changes in these hemodynamic parameters were monitored while performing repeated standardized Valsalva maneuvers. Baseline hemodynamic values were obtained in all 44 participants, and showed an interaction with age, accompanying a significant decline in cardiac index ( r = –.66, p < .05) and stroke volume ( r = –.68, p < .05), and an increase in SVRI ( r = .67, p < .05) with increasing age. The Valsalva maneuver, performed in 20 participants, resulted in a change of 10% from baseline blood pressure and cardiac index, which was detected within 4.53 s ( SD = 4.36) and 3.31 s ( SD = 2.21), respectively. Noninvasive continuous cardiac monitoring demonstrated the ability to rapidly detect logical and predictable hemodynamic changes. These observations suggest that such Nexfin technology may have useful clinical applications.

scholarly journals Continuous cardiac output monitoring in humans by invasive and noninvasive peripheral blood pressure waveform analysis

2006 ◽  
Vol 101 (2) ◽  
pp. 598-608 ◽  
Author(s):  
Zhenwei Lu ◽  
Ramakrishna Mukkamala
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Peripheral Resistance ◽  
Waveform Analysis ◽  
Cardiac Output Monitoring ◽  
Time Interval ◽  
Data Sets ◽  
Data Set ◽  
Arterial Blood ◽  
Output Monitoring

We present an evaluation of a novel technique for continuous (i.e., automatic) monitoring of relative cardiac output (CO) changes by long time interval analysis of a peripheral arterial blood pressure (ABP) waveform in humans. We specifically tested the mathematical analysis technique based on existing invasive and noninvasive hemodynamic data sets. With the former data set, we compared the application of the technique to peripheral ABP waveforms obtained via radial artery catheterization with simultaneous thermodilution CO measurements in 15 intensive care unit patients in which CO was changing because of disease progression and therapy. With the latter data set, we compared the application of the technique to noninvasive peripheral ABP waveforms obtained via a finger-cuff photoplethysmography system with simultaneous Doppler ultrasound CO measurements made by an expert in 10 healthy subjects during pharmacological and postural interventions. We report an overall CO root-mean-squared normalized error of 15.3% with respect to the invasive hemodynamic data set and 15.1% with respect to the noninvasive hemodynamic data set. Moreover, the CO errors from the invasive and noninvasive hemodynamic data sets were only mildly correlated with mean ABP (ρ = 0.41, 0.37) and even less correlated with CO (ρ = −0.14, −0.17), heart rate (ρ = 0.04, 0.19), total peripheral resistance (ρ = 0.38, 0.10), CO changes (ρ = −0.26, −0.20), and absolute CO changes (ρ = 0.03, 0.38). With further development and successful prospective testing, the technique may potentially be employed for continuous hemodynamic monitoring in the acute setting such as critical care and emergency care.

scholarly journals Usefulness of non-invasive cardiac output monitoring in elderly patients undergoing monopolar transurethral resection of the prostate: a pilot study

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092242
Author(s):  
Hae Keum Kil ◽  
In Kyeong Park ◽  
Min Sup Song ◽  
Jin Ha Park
Keyword(s):  
Cardiac Output ◽  
Cardiac Index ◽  
Elderly Patients ◽  
Transurethral Resection ◽  
Cardiac Output Monitoring ◽  
Intravascular Volume ◽  
Volume Depletion ◽  
Non Invasive ◽  
Intravascular Volume Depletion ◽  
Output Monitoring

Objective To assess the impact of irrigating fluid on hemodynamic profiles using real-time non-invasive cardiac output monitoring (NICOM) in elderly patients undergoing monopolar transurethral resection of the prostate (TURP). Methods Twenty patients between 65 and 80 years of age who were scheduled for monopolar TURP and received spinal anesthesia up to T10 were enrolled. Irrigating fluid (2.7% sorbitol with 0.5% mannitol solution) was used. Hemodynamic profiles including cardiac index, and stroke volume variation (SVV) using NICOM were obtained. Estimated irrigating fluid absorption was indirectly calculated. Results The median amount of irrigating fluid used was 6000 mL. The median SVV was 11%, which increased to 12% at 10 minutes after initiating surgery. No significant changes in the cardiac index were observed. The estimated absorption of irrigating fluid was almost zero. Conclusions Although the estimated amount of irrigating fluid that was absorbed was negligible, the increase in SVV may indicate intravascular volume depletion with diuresis resulting from mannitol in the irrigating fluid early during irrigation. Therefore, even during short irrigating times, intensive hemodynamic monitoring should be performed to monitor the possibility of intravascular volume depletion as well as volume overload, especially immediately after large amounts of irrigating fluid are used.

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